This document discusses the development of indicators to measure the performance of community-based HIV programs. It describes an extensive consultation process involving organizations like PEPFAR and the Global Fund. Field tests were conducted in Vietnam and Kenya to evaluate proposed indicators and make recommendations. The final indicators focus on prevention services, prevention materials, care services, and testing and linkages. The indicators are intended to track services at the community level and fill gaps in understanding community programs.

1. Community HIV Program
Indicators
MEASURE Evaluation
Tulane University
Mary Freyder

2. Purpose of Presentation
 Rationale for the community indicator project
 Donor organization consultations
 On-line technical forum series
 Field tests in Vietnam and Kenya
 Description of recommended indicators

3. Rationale
 Reduce reporting burdens for community
based organizations
 Track prevention, care, testing, and linkages
at the community level

4. Aim
 Harmonize PEPFAR and Global Fund
community program indicators
 Improve the technical merit of community
indicators
 Highlight a few of the emerging indicators that
would fill gaps in knowledge about community
programs

5. Extensive International Consultation
 2009 meeting Community Based Information Systems
MEASURE Evaluation in D.C.
 2010 meeting Community Program Indicators
MEASURE Evaluation in D.C.
 2010 meeting Community Systems Strengthening
Global Fund in Geneva
 2010 internal review of Community Program Indicators
all PEPFAR TWGs in D.C.

6. Community of Practice
“The overall goal of the Indicators for Community HIV
Programs CoP is to gather expert opinion on the best
metrics for community HIV program performance and to
gain consensus on minimum standards for monitoring
community HIV services and health outcomes.”
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7. Indicator Selection Criteria
 Represent services that address the continuum of
prevention, treatment, care, and support
 Fully defined and currently used
 Collected/used at the community level and
aggregated/used at national level
 Collected by community-based information system
(non-clinic based)
 Not include indicators from national level surveys or
special studies

8. CoP Recommendations Oct 2011
 Outreach
encounters
 Completed DEBIs
 PwP
 Condom stock-outs
 Needle/Syringe
stock out
 Received HTC
 Completed referral
 One care service
 Undernourished
PLHIV
 Children assessed
for individual needs

9. Field Tests in Vietnam and Kenya
 To assess the need and utility of the
recommended indicators for both CBOs and
national authorities.
 To determine the feasibility of collecting and
analyzing data for the recommended indicators.
 To assess whether or not the draft
recommended indicators are fully defined

10. Mixed Methods Approach
 Individual and small group consultations
 In the style of semi-structured interviews
 Review program records, documents and data
management systems
 In the style of Data Quality Assessments
 Request copies of relevant documents and forms

11. Field Test Participants
 Kenya
 7 community organizations
 35 interviews
 Vietnam
 7 community organizations
 20 interviews

12. Field Test Recommendations (I)
 “Minimum Package of Services” should be
illustrative at the international level
 Focus on developing national guidelines for
community services is important
 Feasibility of data collection per local context
 Validity, i.e. more closely represents the service
 Reliability, i.e. less open to interpretation from one
site to another

13. Field Test Recommendations (II)
 Proposed prevention indicators are feasible
and useful
 encounters, standardized prevention interventions,
stock outs, community PwP services
 One care service important and useful; there
is overlap with PwP
 Completed referrals to a specific service is
possible, but ambitious
 HIV testing, ART defaulters

14. Field Test Recommendations (III)
 Consider counting households receiving care
and support
 Right now a mix of individuals and head of
household under one care service
 The option to count individuals and/or households
 HTC and PWP indicators are from clinic-
based information systems
 Disaggregate by type of site would very useful to
local and national level

15. Field Test Recommendations (IV)
 Uncommon community services; indicators
not required at this time
 Nutrition assessments for PLHIV
 Individual needs assessments for children or
adults
 Supporting or tracking all/various completed
referrals

16. Field Test Recommendations (V)
 Paper-based systems still relevant
 Possible to track # individuals in a reporting
period
 Managing longitudinal records is not possible,
therefore difficult to track:
 needs assessments
 completed referrals
 individual level outcomes

17. Field Test Recommendations (VI)
 Community services found during field test
not represented in indicator list
 HIV prevention with people who injected drugs
 Finding ART defaulters in the community
 ART adherence support

18. Final Indicators for Prevention Services
 Number of HIV prevention outreach encounters
conducted during the reporting period
 Number of people who completed a standardized
HIV prevention intervention during the reporting
period
 Number of people living with HIV/AIDS (PLHIV)
reached with a minimum package of community-
based or home-based interventions for
Prevention with Positives (PwP) during the
reporting period

19. Final Indicators for Prevention Materials
 Number and proportion of days during the
reporting period that stock outs of condoms
occurred at prevention sites
 Number and proportion of days during the
reporting period that stock outs of needles and/or
syringes occurred at prevention sites

20. Final Indicator for Care Services
 Number of adults and children infected and/or
affected by HIV/AIDS who received a minimum
of one community-based or home-based care
and support service during the reporting period
 PLHIV
 OVC
 Caretaker of OVC(s)
 Head of household
 All members of household

21. Final Indicator for Testing and Linkages
 Number and proportion of clients referred to HIV
testing and counseling services by a community-
based program and received their test results in
the reporting period